A number of people know very little about angioplasty and often give in to pressure exerted by cardiologists .Cardiologists say not all heart attack patients need to undergo an angioplasty. If the ECG report indicates ST elevation myocardial infraction (one or more arteries are 100% blocked), then an angioplasty must be done within the first six hours. In the case of non-ST elevation myocardial infraction (one or more arteries are less then 90%blocked), the need for an angioplasty can be evaluated after 24 hours.
"In ST elevation, the blocked artery is supplying no blood to the heart, which makes it necessary to clear the artery, " said Dr V K Bahl, head of the cardiology department, AIIMS.
Doctors say a primary angioplasty is of little use if done after 12 hours in ST elevation MI patients. "The part of the heart supplied blood by the blocked artery will be dead by then. We will not be able to revive it by opening the artery so there is no point," said Dr. Neeraj Bhalla, senior interventional cardiologist, Max Healthcare.
Since not many people are aware of this basic difference, families are quick to give their consent to an angioplasty. For non-ST elevation heart attack patients, doctors say there are tests available to evaluate the need for an angioplasty
Doctors say the location of the block, the severity of the block and the type of diseased artery are some of the crucial factors that have to be kept in mind.
"If the block is towards the end of the artery, then we don't need to an angioplasty because the area supplied by it is very small. Cardiologists don't usually touch an artery if the block is less than 70%, " said Dr. Upender Kaul, senior interventional cardiologist, Fortis Healthcare.
But it is important to evaluate the patient in totality. In a heart attack patient with underlying medical complications sometimes doing an angioplasty is a must. Dr. Praveen Chandra, Chairman, division of interventional cardiology, Medanta, Medicity, agrees. "We have to evaluate a patient in totality. If there is 60% blockage towards the start of one of the main arteries, then we might consider opening it with the use of a stent. A patient's age is also an important criterion."
Experts say people with stable anginas are also undergoing angioplasties. With various private and public sector companies including angioplasty in their list of medical benefits for employees, experts say this has resulted in its misuse.
"Minor abnormalities in treadmill test are highlighter and people are advised angioplasties. Since the employee doesn't have to from his pocket, he is quick to give his consent. Nearly 2% to 5 % of angioplasties are done on such patients," said a Sr. executive with a stent-manufacturing company.
A recent large - scale trial -the Courage Trial - in the US showed medical therapy is as good as a bypass or interventional procedure in stable angina patients.
"Stable angina patients should first be given medical therapy. If pain persists, then they should be considered for an angioplasty. Doing an angioplasty in stable angina patients doesn't rule out the risk of heart attack in the future," said Dr Bahl.
The decision to undergo in for angioplasty should not be made by a cardiologist alone. A team of doctor should examine a patient and then decide. Every efforts should be made to ensure that an angioplasty should be done only on a patient who really needs it.
Doctors say in young patients of heart attack angiography has better results. "It is important to open a blocked artery in young patients as he has a long life ahead and his chances of suffering another attack are high. We have to ensure that all his arteries are open," said Dr. Lal. for the benefit of all placed here:source: exerpts from TOI dated 18.5.10